Unusual Changing Calcification Patterns on the Mammogram in a Pure Mucocele-Like Lesion of the Breast: A Case Report
Challenging differential diagnosis, Rare disease
Suk Jung Kim, Ji Yeon Kim
Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
Am J Case Rep 2019; 20:926-932
Mucocele-like lesions are rare breast lesions composed of mucin filled cysts and extravasated mucin that frequently undergo calcification. The most common radiologic feature of a mucocele-like lesion is mammographic microcalcifications of indeterminate nature. The present report demonstrated unusual fluctuation of calcification number and a changing pattern of calcification morphology on mammography in a benign mucocele-like lesion.
CASE REPORT: A 39-year-old female was referred to our breast clinic because of a screening mammography-detected abnormality in her right breast. The magnification mammogram of her right breast revealed approximately 8 cm of multiple adjacent masses accompanying regional coarse heterogeneous microcalcifications in the inner central area, which corresponded to multiple aggregated cystic lesions on sonography. Each cystic lesion had internal echoes of a complex cystic with solid and septated pattern. Although a biopsy was recommended, the patient refused the tissue diagnosis. During the first 12 months, the overall extent of mass and calcifications did not discernably change on magnification mammograms. However, minute focal changes in the calcification number were detected; single coarse calcification disappeared at 6-month follow-up, and new coarse calcification developed at 12-month follow-up. At 24-month follow-up magnification mammogram, coarse calcification overtly increased in number and size, and changed into a large bizarre dystrophic morphology. A pathologic diagnosis of a benign mucocele-like lesion without upgrade to atypia or malignancy was made using ultrasonography-guided vacuum-assisted biopsy and surgical excision.
CONCLUSIONS: When calcifications accompany cystic masses and chronologically change their morphologic pattern from indeterminate (coarse heterogeneous) to benign (dystrophic), a diagnosis of mucocele-like lesion should be considered.
Keywords: Breast, Mammography, Mucocele, Ultrasonography, Mammary